CHAPTER II.

THE MEDICINE OF HIPPOCRATES AND HIS PERIOD. Hippocrates first delivered Medicine from the Thraldom of Superstition.—Dissection of the Human Body and Rise of Anatomy.—Hippocrates, Father of Medicine and Surgery.—The Law.—Plato. Hippocrates, the “Father of Medicine,” was born at Cos,[384] 460 B.C. On his father’s side he was believed to be descended from Æsculapius, and through his mother from Hercules. A member of the family of the Asclepiadæ, of a descent of three hundred years, he had the advantage of studying medicine under his father, Heraclides, in the Asclepion of Cos. Herodicus of Selymbria taught him medical gymnastics, and Democritus of Abdera and Gorgias of Leontini were his masters in literature and philosophy. He travelled widely, and taught and practised at Athens, dying at an age variously stated as 85, 90, 104, and 109. Fortunate in the opportunities offered by his birth and position, he was still more fortunate in his time—the age of Pericles—in which Greece reached its noblest development, and the arts and sciences achieved their greatest triumphs. It was the age of Socrates, Plato, Xenophon, Euripides, Sophocles, Æschylus, Pindar, Aristophanes, Herodotus, Thucydides, and Phidias. Philosophy, poetry, literature, and sculpture found in these great minds their most perfect exponents. Medicine, in the person of Hippocrates, was to find its first and most distinguished author-physician. The Father of Medicine was therefore the worthy product of his remarkable age. The genius which culminated in the works of the golden age of Greece could scarcely have left medicine without her Hippocrates; the harmony otherwise would have been incomplete. The following genealogy of Hippocrates has been given by Tzetzes, but Mr. Grote says it is wholly mythical:— Æsculapius was the father of Podalirius, who was the father of Hippolochus, who was the father of Sostratus, who was the father of Cleomyttades, who was the father of Theodorus, who was the father of Sostratus II., who was the father of Theodorus II., who was the father of Sostratus III., who was the father of Nebrus, who was the father of Gnosidicus, who was the father of Hippocrates I., who was the father of Heraclides, who was the father of Hippocrates II., otherwise called the Great Hippocrates. Hippocrates was the first physician who delivered medicine from the thraldom of superstition and the sophistries of philosophers, and gave it an independent existence. It was impossible that our science should make progress so long as men believed that disease was caused by an angry demon or an offended divinity, and was only to be cured by expelling the one or propitiating the other. Hippocrates, with a discernment and a courage which was marvellous, considering his time, declared that no disease whatever came from the gods, but was in every instance traceable to a natural and intelligible cause. Before the Asclepiadæ there was no medical science; before Hippocrates there was no one mind with vision wide enough to take in all that had been done before—to select the precious from the worthless and embody it in a literature which remains to the present time a model of conciseness and condensation, and a practical text-book on all that concerns the art of healing as it was understood in his time. The minuteness of his observations, his rational, and accurate interpretation of all he saw, and his simple, methodical, truthful, and lucid descriptions of everything which he has recorded excite the admiration and compel the praise of all who have studied the works which he has left. Nor are his candour, honesty, caution, and experience less to be extolled. He confesses his errors, fully explains the measures adopted to cure his cases, and candidly admits that in one series of forty-two patients whom he attended only seventeen recovered, the others having perished in spite of the means he had proposed to save them. He was probably the first public teacher of the healing-art; his counsels were not whispered in the secret meetings of sacerdotal assemblies. He was the first to disclose the secrets of the art to the world; to strip it of the veil of mystery with which countless generations of magicians, thaumaturgists, and priestly healers had shrouded it, and to stand before his pupils to give oral instruction in anatomy and the other branches of his profession. Had he not been the Father of Medicine, he would have been known as one of the greatest of the philosophers. He first recognised Φύσις—Nature in the treatment of disease. Nature, he declared, was all-sufficient for our healing. She knows of herself all that is necessary for us, and so he called her “the just.” He attributed to her a faculty, Δύναμις; physicians are but her servants. The governing faculty, Δύναμις, nourishes, preserves, and increases all things. Galen states that the greater part of Aristotle’s physiology was taken from Hippocrates. It has been the custom to make light of his anatomical knowledge, and to say that in face of the difficulty, if not impossibility, of procuring subjects for dissection, he could have had but little exact knowledge of the human body; but it is certain that by some means or other he must have dissected it. In proof of this it is only necessary to mention his treatise _On the Articulations_, especially that part of it which relates to the dislocation of the shoulder joint. Dr. Adams, in one of his valuable notes on the works of Hippocrates,[385] says: “The language of our author in this place puts it beyond all doubt that human dissection was practised in his age.” In Ashurst’s _International Encyclopædia of Surgery_[386] his descriptions of all dislocations are declared to be wonderfully accurate; and the writer adds that it is the greatest error imaginable to suppose, with the common conceit of our day, that all ingenious and useful improvements in surgery belong to the present age. In the treatise on the Sacred Disease (epilepsy), his description of the brain in man proves that he was acquainted with its dissection. In the treatise on the heart, again, the construction of that organ in the human body is referred to. Other allusions to the internal structure of the human frame in the Hippocratic treatises serve to confirm our opinion; and if it be objected that some of these are probably not genuine, they must at least be as old as his period, and it was far more likely that he should have written or inspired them than that they should have emanated from an inferior source. Those who argue to the contrary do so on the same grounds as the Greek commentators, who say that the _Iliad_ and _Odyssey_ were not written by Homer, but by some other poet of the same name. Dr. Adams is confident, from his familiarity with the works of Hippocrates, that the knowledge of human anatomy exhibited therein had its origin in actual dissection, and he adds that: “I do not at present recollect a single instance of mistake committed by him in any of his anatomical descriptions, if we except that with regard to the sutures of the head, and even in that case I have endeavoured to show that the meaning of the passage is very equivocal.”[387] There is no doubt, in fact, that a great deal more human dissection went on than the Greek doctors dared to acknowledge for fear of exciting popular prejudice. Less than a hundred years after the death of Hippocrates there was abundant and open dissection of the human body in the schools of Alexandria, and it is incredible that the practice only received popular sanction at that particular time. Yet the anatomy of Hippocrates was very imperfect. The nerves, sinews, and ligaments were confounded together, all being classed as νεῦρον or τόνος. The blood-vessels were supposed to contain both blood and air, and were called φλέβες; the trachea was called an “artery.” The brain was considered as merely a gland which condenses the ascending vapours into mucus. The office of the nerves was to convey the animal spirits throughout the body. We must not forget that the science of anatomy was extremely imperfect even at the beginning of the present century. “When,” says Littré,[388] “one searches into the history of medicine and the commencement of the science, the first body of doctrine that one meets with is the collection of writings known under the name of the works of Hippocrates. The science mounts up directly to that origin, and there stops. Not that it had not been cultivated earlier, and had not given rise to even numerous productions; but everything that had been made before the physician of Cos has perished. We have only remaining of them scattered and unconnected fragments. The works of Hippocrates have alone escaped destruction; and by a singular circumstance there exists a great gap after them as well as before them. The medical works from Hippocrates to the establishment of the school of Alexandria, and those of that school itself, are completely lost, except some quotations and passages preserved in the later writers; so that the writings of Hippocrates remain alone amongst the ruins of ancient medical literature.” It is vain to inquire how Hippocrates acquired a knowledge which seems to us so far in advance of his age. Was Greek wisdom derived from the East, or was its philosophy the offspring of the soil of Hellas? Such questions have often been discussed, but to little purpose. There would seem to be every reason to suppose that Greek medicine was indigenous. We have no means of knowing how long philosophy and medicine had been united before the time of Hippocrates. The honour of affecting the alliance has been ascribed to Pythagoras. Several of the Greek philosophers speculated about medicine. We have seen that besides Pythagoras, Empedocles and Democritus did so, although it is not probable that they followed it as a profession. The Asclepiadæ probably brought medicine to a high state of perfection, but the work these priest-physicians did is a sealed book to us. All was darkness till Hippocrates appeared. In his treatise _On Ancient Medicine_, he says that men first learned from experience the science of dietetics; they were compelled to ascertain the properties of vegetable productions as articles of food. Then they learned that the food which is suitable in health is unsuitable in sickness, and thus they applied themselves to the discovery of the proper rules of diet in disease; and it was the accumulation of the facts bearing on this subject which was the origin of the art of medicine. “The basis of his system was a rational experience, and not a blind empiricism; so that the empirics in after ages had no good grounds for claiming him as belonging to their sect.”[389] He assiduously applied himself to the study of the natural history of diseases, especially with the view to determine their tendencies to death or recovery. In every case he asked himself what would be the probable end of the disorder if left to itself. Prognosis, then, is one of the chief characteristics of Hippocratic medicine. He hated all charlatanism, and was free from all popular superstition. When we reflect on the medicine of the most highly civilized nations which we have considered at length in the preceding pages, and remember how full of absurdities, of magic, amulet lore, and other things calculated to impose on the credulity of the people, were their attempts at healing, we shall be inclined to say, that the most wonderful thing in the history of Hippocrates was his complete divorce from the evil traditions of the past. Although he forsook philosophy as an ally of medicine, his system was founded in the physical philosophy of the elements which the ancient Greeks propounded, and which we have attempted to explain. There was an all-pervading spiritual essence which is ever striving to maintain all things in their natural condition; ever rectifying their derangements; ever restoring them to the original and perfect pattern. He called that spiritual essence Nature. “Nature is the physician of diseases.”[390] Here, then, we have the enunciation of the doctrine of the _Vis Medicatrix Naturæ_. In his attempts to aid Nature, the physician must regulate his treatment “to do good, or at least, to do no harm”;[391] yet he bled, cupped, and scarified. In constipation he prescribed laxative drugs, as mercury (not the mineral, of course, but _Mercurialis perennis_), beet, and cabbage, also elaterium, scammony, and other powerful cathartics. He used white hellebore boldly, and when narcotics were required had recourse to mandragora, henbane, and probably to poppy-juice. He is said to have been the discoverer of the principles of derivation and revulsion in the treatment of diseases.[392] Sydenham called Hippocrates “the Romulus of medicine, whose heaven was the empyrean of his art. He it is whom we can never duly praise.” He terms him “that divine old man,” and declares that he laid the immovable foundations of the whole superstructure of medicine when he taught that _our natures are the physicians of our diseases_.[393] He was Father of Surgery as well as of medicine. Eight of his seventeen genuine works are strictly surgical. By an ingenious arrangement of apparatus he was enabled to practise extension and counter-extension. He insisted on the most exact co-aptation of fractured bones, declaring that it was disgraceful to allow a patient to recover with a crooked or shortened limb. His splints were probably quite as good as ours, and his bandaging left nothing to be desired. When the ends of the bones projected in cases of compound fractures, they were carefully resected. In fracture of the skull with depressed bone the trepan was used, and in cases where blood or pus had accumulated they were skilfully evacuated. He boldly and freely opened abscesses of the liver and kidneys. The thoracic cavity was explored by percussion and auscultation for detection of fluids, and when they were discovered paracentesis (tapping) was performed. This was also done in cases of abdominal dropsies. The rectum was examined by an appropriate speculum, fistula-in-ano was treated by the ligature, and hæmorrhoids were operated upon. Stiff leather shoes and an admirable system of bandaging were employed in cases of talipes. The bladder was explored by sounds for the detection of calculi; gangrenous and mangled limbs were amputated; the dead fœtus was extracted from the mother. Venesection, scarification, and cupping were all employed.[394] He resected bones at the joints. In the treatment of ulcers he used sulphate of copper, sulphate of zinc, verdigris, lead, sulphur, arsenic, alum, etc. He came very near indeed to the antiseptic system in surgery when he made use of “raw tar water” (a crude sort of carbolic acid, in fact) in the treatment of wounds. Suppositories were employed. In Dr. Adams’ _Life of Hippocrates_,[395] he says: “In surgery he was a bold operator. He fearlessly, and as we would now think, in some cases unnecessarily, perforated the skull with the trepan and the trephine in injuries of the head. He opened the chest also in empyema and hydrothorax. His extensive practice, and no doubt his great familiarity with the accidents occurring at the public games of his country, must have furnished him with ample opportunities of becoming acquainted with dislocations and fractures of all kinds; and how well he had profited by the opportunities which he thus enjoyed, every page of his treatises _On Fractures_ and _On the Articulations_ abundantly testifies. In fact, until within a very recent period, the modern plan of treatment in such cases was not at all to be compared with his skilful mode of adjusting fractured bones, and of securing them with waxed bandages. In particular, his description of the accidents which occur at the elbow and hip-joints will be allowed, even at the present day, to display a most wonderful acquaintance with the subject. In the treatment of dislocations, when human strength was not sufficient to restore the displacement, he skilfully availed himself of all the mechanical powers which were then known. In his views with regard to the nature of club-foot, it might have been affirmed of him a few years ago that he was twenty-four centuries in advance of his profession, when he stated that in this case there is no dislocation, but merely a declination of the foot; and that in infancy, by means of methodical bandaging, a cure may in most cases be effected without any surgical operation. In a word, until the days of Delpech and Stromeyer, no one entertained ideas so sound and scientific on the nature of this deformity as Hippocrates.” Dr. Adams, recapitulating the general results of the investigations as to the genuineness of the Hippocratic books, states that a considerable portion of them are not the work of Hippocrates himself. The works almost universally admitted to be genuine are: _The Prognostics_, _On Airs_, etc., _On Regimen in Acute Diseases_, seven of the books of _Aphorisms_, _Epidemics_, I. and III., _On the Articulations_, _On Fractures_, _On the Instruments of Reduction_, _The Oath_. The following are almost certainly genuine: _On Ancient Medicine_, _On the Surgery_, _The Law_, _On Ulcers_, _On Fistulæ_, _On Hæmorrhoids_, _On the Sacred Disease_.[396] THE LAW.